Ten year experience with induction therapy in locally advanced non-small cell lung cancer (NSCLC): is clinical re-staging predictive of pathological staging?

Objective. To verify if in our experience with 'induction therapy' in non-small cell lung cancer (NSCLC) the clinical re-staging is really predictive of pathological staging Materials and methods: From January 1990 to February 2000, 136 patients with locally advanced NSCLC underwent a protocol of induction therapy according to three different treatment plans: Carboplatin + radiotherapy - study A; Cisplatin + 5-Fluorouracil + radiotherapy - study B; Gemcitabine + radiotherapy - study C. Results: Clinical re-staging showed in the patients enrolled in study A a clinical Complete Response rate (cCR) of 2.3%: a clinical Partial Response rate (cPR) of 50%: a clinical Stable Disease (cSD) rate of 44.3%; a clinical Disease Progression (cDP) rate of 3.4%. In study B, cCR was 0%; cPR: 71.4%: cSD 10.7%; cDP: 17.9%. In study C, cCR was 0%; cPR: 23.5%; cSD: 11.8%; cDP: 64.7%. After clinical re-staging, 76 patients (47 group A: 23 group B: 6 group C) were judged to be resectable and underwent a surgical operation. Pathological staging showed no tumour in eight patients (10.5%: 8/76) (three in study A, four in study B, one in study C and microscopic neoplastic remnants in seven (9.2% 7/76). Thirty-nine patients were pN0. Overall downstaging rate in the operated patients was 51%. No precise correlation was found among clinical re-staging and pathological staging. We had two cCRs and eight pCRs, and all of these pCRs had been re-staged as cPR except in one case (cSD). In seven cases, where only microscopic remnants have been found, six had been clinically restaged as cPR and one as cSD. Conclusions: Our experience confirmed how often the clinical re-staging data are unreal. Accordingly surgery should he indicated in any case where an induction therapy has been administered, if it is reasonably possible. (C) 2001 Elsevier Science B.V. All rights reserved.